Stanford Plastic Surgery - Peripheral Nerve Center

Nerve compressions are very common and can cause loss of function and pain.  In nerve compression, the nerve is swollen and gets ”pinched.” This can be very painful.  The most common nerve compression is carpal tunnel syndrome, which results in numbness in the hand.  There are many other nerves that can be compressed all over the body.  For example, nerves can be compressed around the ankle causing numbness in the foot (this is especially true in diabetics). 

Diabetics with neuropathy (numbness in the hands and/or feet) can also have compressed nerves that worsen their numbness.  Surgery for these patients can improve their sensation.

 Nerves can be compressed in the back of the head causing severe head pain. This can be seen after whiplash or occur spontaneously. Occipital nerve compression is a common cause of back of head pain and surgery can relieve this pain.   These types of procedures are often called “migraine surgery.”

Anywhere a nerve goes through a tight spot there is the potential for pinching.  The good news is that releasing the pinch can often result in decreased pain and improved function.  The real challenge is in the diagnosis, figuring out which nerve is pinched, and at what level. 

A list of some of the pinched nerves we treat: occipital neuralgia, carpal tunnel syndrome, cubital tunnel syndrome, tarsal tunnel syndrome, peroneal nerve compression, radial tunnel, pronator syndrome, and meralgia parasthetica.

Injured nerves can cause pain that is severe.  Nerves can be injured by trauma or surgery.  These painful nerves can occur through out the body. Pain after foot and ankle surgery or breast surgery or amputations can all be due to neuroma formation.

Treatment for neuroma pain has recently undergone large advances.  There are new surgical techniques such as regenerative peripheral nerve interface (RPNI) and targeted muscle re-innervation (TMR) that show decreased pain.  The difficulty is in diagnosis of the location of nerve injury.  This generally requires a diagnostic block using local numbing medication to confirm the location of the neuroma.

Nerves can be cut after trauma.  This results in loss of function in the nerve and surgery is required to fix a nerve laceration.  Repairing a nerve requires magnification, often surgical loupes or a microscope are used, and fine sutures.  The nerve will regrow an inch a month.  Thus depending on where the nerve laceration occurs recovery can take months to years. After repair, rehabilitation is an important aspect to ensure the best recovery.

Phantom limb pain/amputation pain – this pain is caused by the cut nerves in the amputated stump.  These pains can be very debilitating and can prevent patients from wearing prosthesis.  There are new techniques available to treat this pain, including regenerative peripheral nerve interface (RPNI) and targeted muscle re-innervation (TMR). These procedures can be performed many years after the original injury and still give relief.

Brachial Plexus Injury- is an injury to the nerves that supply the arm.  These complex injuries occur after major trauma and require a holistic approach.  Often these injuries will recover without surgery but still require therapy to keep the upper limb supple.  Surgery can be repairing the nerve with nerve grafts or nerve transfers.  Nerve transfers are a newer technique.  In this case working nerves are rewired to the injured nerves.  This gives the patient a better chance of recovery.  Sometimes tendon transfers are used for severe nerve injuries.  In this technique, working tendons are rerouted to do a missing function.  For example, in a person who is unable to straighten their fingers, we can use a tendon that bends the wrist (you have two so we can steal one) and reroute it to straighten the fingers.  The critical issue with brachial plexus injuries is that time is of the essence.  Our treatments can only be performed in a tight time window so patients should be seen as early as possible.

Cervical Spinal Cord Injury - Patients with spinal cord injury have a central nervous system injury.  However, sometimes we can reroute the nerves and tendons that are working to help those that are weak or not working.  These surgeries can provide spinal cord injury patients with the ability to pinch and grasp.